Field
The present disclosure generally relates to systems and methods facilitating optimization of patient care, and, in particular, relates to monitoring of ventilated patient sedation, pain therapy and the process of weaning ventilated patients off of the ventilator.
Description of the Related Art
Mechanical ventilator patients, who are intubated in a care facility, typically receive sedation and pain therapy from an infusion pump, as well as life-support from the mechanical ventilator device. Typically, a Nurse operates the infusion pump and has the overall responsibility for the patient. The ventilator is typically operated by a Respiratory Therapist.
The mechanical ventilator provides life support by assisting the patient with the inhalation of oxygen and the exhalation of CO2 in order to maintain the necessary PaO2, PaCo2 and pH arterial blood levels, when the patient is unable to sustain adequate levels with their own spontaneous breathing. Positive pressure mechanical ventilators pump air with a controllable percentage of inspired oxygen (21%-100%) during the inspiratory phase of the breathing cycle. When the inspiratory phase of the breathing cycle is complete, the patient exhales through the ventilator by utilizing the natural recoil characteristics of the lungs. The volume of air that is introduced into the lungs on each cycle is the “tidal volume.” This process is very invasive and introduces a high potential for complications such as baro trauma and secondary infections. Furthermore, the analgesics (or other pain medication) and sedatives commonly prescribed to such patients to provide patient comfort can themselves lead to adverse patient outcomes.
Thus, it is desirable to end the use of a mechanical ventilator as early as possible. Many of the rules and protocols for transitioning a patient off of a mechanical ventilator, or “weaning” the patient, include a series of clinical interventions including sedation and pain therapy management where the amount of sedatives and analgesics or other pain medications is reduced to awaken the patient and enable the return of their natural respiratory drive. “Spontaneous awakening trials” or “sedation vacations” where the patient is awakened as tolerated and monitored, and “spontaneous breathing trials” or “weaning trials” where the ventilator support is reduced or stopped for a period of time and the patient is monitored during the trial to identify signs of distress or difficulty. If the patient is able to successfully complete the prescribed weaning trials, “extubation” may be performed where the ventilator is removed, or the patient may be put back on full support to further prepare them for extubation.
Such interventions that facilitate a total dose reduction in analgesic and sedative medications such as the use of nurse controlled protocol guided sedation, the combination of spontaneous awakening and breathing trials, and the use of short acting medications, are associated with improved outcomes such as decreased time of mechanical ventilation and ICU length of stay. Titration of individual patients' sedation throughout their ICU admission is also managed to reduce over-sedation and side-effects, and contributes to reduced duration of mechanical ventilation and length of stay.